Knee Pain and Problems | Johns Hopkins Medicine

Knee pain is a common complaint among adults and most often associated with general wear and tear from daily activities like walking, bending, standing and lifting. Athletes who run or play sports that involve jumping or quick pivoting are also more likely to experience knee pain and problems. But whether an individual’s knee pain is caused by aging or injury, it can be a nuisance and even debilitating in some circumstances.

What You Need to Know

• The most common causes of knee pain are related to aging, injury or repeated stress on the knee.
• Common knee problems include sprained or strained ligaments, cartilage tears, tendonitis and arthritis.
• Diagnosing a knee injury or problem includes a medical examination and usually the use of a diagnostic procedure(s) such as an x-ray, MRI, CT scan or arthroscopy.
• Both non-operative and surgical treatment options are available to treat knee pain and problems depending on the type and severity of the condition.

Brief anatomy of the knee 

The knee is a vulnerable joint that bears a great deal of stress from everyday activities, such as lifting and kneeling, and from high-impact activities, such as jogging and aerobics.

The knee is formed by the following parts:

• Tibia. This is the shin bone or larger bone of the lower leg.

• Femur. This is the thighbone or upper leg bone.

• Patella. This is the kneecap.

Each bone end is covered with a layer of cartilage that absorbs shock and protects the knee. Basically, the knee is 2 long leg bones held together by muscles, ligaments, and tendons.

There are 2 groups of muscles involved in the knee, including the quadriceps muscles (located on the front of the thighs), which straighten the legs, and the hamstring muscles (located on the back of the thighs), which bend the leg at the knee.

Tendons are tough cords of tissue that connect muscles to bones. Ligaments are elastic bands of tissue that connect bone to bone. Some ligaments on the knee provide stability and protection of the joints, while other ligaments limit forward and backward movement of the tibia (shin bone).

What are some common knee problems?

Many knee problems are a result of the aging process and continual wear and stress on the knee joint (such as, arthritis). Other knee problems are a result of an injury or a sudden movement that strains the knee. Common knee problems include the following:

• Sprained or strained knee ligaments and/or muscles. A sprained or strained knee ligament or muscle is usually caused by a blow to the knee or a sudden twist of the knee. Symptoms often include pain, swelling, and difficulty in walking.

• Torn cartilage. Trauma to the knee can tear the menisci (pads of connective tissue that act as shock absorbers and also enhance stability). Cartilage tears can often occur with sprains. Treatment may involve wearing a brace during an activity to protect the knee from further injury. Surgery may be needed to repair the tear.

• Tendonitis. Inflammation of the tendons may result from overuse of a tendon during certain activities such as running, jumping, or cycling. Tendonitis of the patellar tendon is called jumper’s knee. This often occurs with sports, such as basketball, where the force of hitting the ground after a jump strains the tendon.

• Arthritis. Osteoarthritis is the most common type of arthritis that affects the knee. Osteoarthritis is a degenerative process where the cartilage in the joint gradually wears away. It often affects middle-age and older people. Osteoarthritis may be caused by excess stress on the joint such as repeated injury or being overweight. Rheumatoid arthritis can also affect the knees by causing the joint to become inflamed and by destroying the knee cartilage. Rheumatoid arthritis often affects persons at an earlier age than osteoarthritis.

Seminar

Management of Knee Arthritis

Have you been diagnosed with arthritis of your knees? Watch this webinar with Dr. Vishal Hegde, hip and knee surgeon and Assistant Professor of Orthopaedic Surgery at Johns Hopkins as he discusses the diagnosis and management of knee osteoarthritis and treatment options to improve your function to get you back to the activities you enjoy.

Watch this webinar

How are knee problems diagnosed?

In addition to a complete medical history and physical exam, other tests for knee problems may include:

• X-ray. This test uses invisible electromagnetic energy beams to make images of internal tissues, bones, and organs onto film.

• Magnetic resonance imaging (MRI). This test uses large magnets, radiofrequencies, and a computer to make detailed images of organs and structures within the body; can often determine damage or disease in a surrounding ligament or muscle.

• Computed tomography scan (also called a CT or CAT scan). This test uses X-rays and computer technology to make horizontal, or axial, images (often called slices) of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general X-rays.

• Arthroscopy. A minimally-invasive diagnostic and treatment procedure used for conditions of a joint. This procedure uses a small, lighted, optic tube (arthroscope), which is inserted into the joint through a small incision in the joint. Images of the inside of the joint are projected onto a screen; used to evaluate any degenerative or arthritic changes in the joint; to detect bone diseases and tumors; to determine the cause of bone pain and inflammation.

• Radionuclide bone scan. A nuclear imaging technique that uses a very small amount of radioactive material, which is injected into the patient’s bloodstream to be detected by a scanner. This test shows blood flow to the bone and cell activity within the bone.

Treatment for knee problems

If initial treatment methods do not provide relief, and X-rays show destruction of the joint, the orthopaedist may recommend total joint replacement for the knee, also referred to as knee replacement.

ACL Tears in Female Athletes: Q&A with a Sports Medicine Expert

Sports injury prevention isn’t a one-stop shop, especially for injuries like ACL tears, which are four to eight times more common among women than men. Discover ways for women to help prevent this common injury.

Read more

How Your Doctor Will Find Out What’s Wrong

Written by Karyn Repinski

• 8 Questions Your Doctor May Ask
• Physical Exam
• Imaging Tests
• Lab Tests

Even if your knee injury happened a while ago, it can still cause pain. But so can many other things, including arthritis and other conditions. To find out what’s going on in your case, you’ll need to see your doctor.

At that visit, you’ll talk about your symptoms and the injury. You’ll also get a physical exam, and you may need to get an X-ray, MRI, CT scan, or other tests.

Your doctor will want to know as much as possible about what’s going on with your knee. Be ready to answer questions such as:

1. When did the pain start?
2. Where does it hurt: the front, center, side, or back of the knee?
3. Did it start suddenly or slowly?
4. How would you describe the pain: dull, sharp, or achy?
5. Is the pain always there, or just now and then?
6. Is there any swelling or redness? Does it feel warm?
7. Do any activities make the pain better or worse?
8. Did your pain start because of a specific injury? If so, your doctor will want specific details of what happened, including what you were doing and whether you had to stop right away.

Your answers will give your doctor clues about the cause of your pain. For instance, a popping or snapping sound may mean that you tore a ligament. If your pain is worse when you rest and your knee is stiff when you wake up, you could have a type of arthritis.

Your doctor will also ask about:

• Problems with any other joints
• Any knee injuries or surgeries you’ve had
• Other health issues that might be causing the pain

A hip problem, for example, can cause you to walk awkwardly, which throws off alignment of your knees, causing pain. Also, pain from your hip can make your knee hurt.

Let your doctor know what you’ve already tried to treat your knee pain, such as medicines, braces, and physical therapy.

First, your doctor will compare your painful knee with your healthy one, looking for any differences.

DID YOU KNOW?

When you get your knee examined, you may need to stand, walk, or squat so your doctor can see how well your knee moves.

In addition to redness, swelling, bruising, and discoloration, your doctor will check for differences in your muscles. Knee pain often happens the when the outer muscles of the thigh are stronger than those in the mid-thigh (causing the kneecap to be pulled “off track”), so your doctor will pay particular attention to the vastus medialis, a muscle in your mid-thigh that extends to the knee.

You doctor will also feel your knee, checking for pain, warmth, and swelling. They will then bend, straighten, rotate, or press on the knee to feel for injury and find out how well the knee moves and where the pain is.

Depending on your medical history and the findings of the physical exam, your doctor may recommend one or more of these tests to see inside your knee:

X-ray. This quick, painless test produces a 2-dimensional picture of your bones that helps find breaks and joint disease like osteoarthritis.

CT scan. It combines X-rays taken from many different angles to give a 3-dimensional view of the knee. The test shows much more detail of the bones than regular X-rays, and it can help diagnose bone problems and find breaks in bones that X-rays may not pick up.

Bone scan. This test creates images of bones on a computer screen or film. First, you’ll get a harmless radioactive material injected into your bloodstream. The material collects in the bones, particularly in abnormal areas of the bones, and shows up on a scanner.

MRI. In this test, a powerful magnet linked to a computer creates pictures of areas inside the knee. It’s useful for finding damage to soft tissue, such as muscles, ligaments, cartilage, and tendons.

Your doctor may order laboratory tests to confirm a diagnosis. For instance, an analysis of fluid taken from your knee can spot an infection, inflammation, or gout. The procedure can also help relieve pain and pressure.

Top Picks

Knee ligament rupture – symptoms and treatment

Every day we take thousands of steps, go up and down stairs, squat, play sports. The special structure of the knee joint, including the presence of ligaments, makes it possible to perform these movements freely and without pain. The knee ligaments (there are four in total: two cruciate and two external) ensure the correct position of the joint and its stability. The anterior and posterior cruciate ligaments hold the knee forward and backward. When moving to the side, the joint is fixed by the internal and external lateral ligaments (medial and lateral). By themselves, these structures are very strong, however, physical overload, injuries and diseases of the joints can cause damage to the knee ligaments.

Damage to the ligaments of the knee joint

Specialists identify several degrees of damage to the knee joint.

1. Partial ligament tear, which is very often called sprain
2. Incomplete knee ligament tear is knee ligament tear when only part of the fibers is damaged
3. Complete knee tear ligaments

The most commonly affected is the anterior cruciate bundle. This damage occurs during active sports (skiing, playing football). Often, a knee ligament tear occurs with a sharp change in movement, an unsuccessful landing after a jump, a fall, when the tibia abruptly mixes inward.

Damage to the medial lateral ligament of the knee is also common. The mechanism of injury is very similar to an anterior cruciate ligament injury.

Tears of the external lateral ligament and injuries of the posterior cruciate ligament are uncommon. Such injuries are usually caused by road accidents or very severe injuries in sports.

Knee ligament rupture symptoms and signs of manifestation

Symptoms vary depending on which ligament is injured. But there are several manifestations that are characteristic of damage to all ligaments of the knee joint.

• At the time of injury, a characteristic sound is heard – a click, crackling, crackling of a torn ligament
• Severe sharp pain in the knee joint
• Swelling of the knee with hemorrhage
• Restriction of mobility
• Instability in the joint.

All of these manifestations indicate problems with the knee ligaments. In this case, it is urgent to be examined, determine the degree of damage to the ligaments and decide on treatment. It is impossible to make a diagnosis on your own – after knee injuries, our patients often attributed everything to a banal sprain, which turned into a more serious injury and entailed unpleasant consequences. Therefore, if you are injured, consult a doctor.

How to treat a knee ligament tear

For less complex injuries, it is possible to get by with only conservative therapy. But when there is complete or partial damage to the ligaments of the knee joint, there has been a complete rupture or separation of the ligament from the attachment site, surgery is needed. Arthroscopic surgery is performed in our clinic for such indications.

Operation on knee ligaments in case of rupture

Restoration of the ligamentous apparatus of the knee joint with the help of surgical intervention – arthroscopy of the knee joint. This low-traumatic technique allows effective treatment of knee ligaments through small punctures.

The Orthopedics Clinic also performs ligament plasty using the patient’s own tendon. To do this, access to the joint is made through incisions of several millimeters, with the help of special navigation systems, new holes are made to fix the graft in the bone. First, a hole is created in the thigh, then a hole is made in the tibia using the navigator. Often, the patient’s own tendon is used as a graft to repair the ligament.

The graft is sutured in a special way: inserted into pre-drilled channels in the femur and tibia and fixed in them. On the tibia, the graft is fixed with a self-absorbable screw (it does not need to be removed again). After some time, the ligament takes root and fills the space of the damaged knee joint complex.

Rehabilitation after knee ligament rupture

In order to return the joy of movement to patients, our clinic uses an integrated approach. That is, by contacting the orthopedics clinic, the patient receives all the necessary assistance: from consultation to postoperative recovery.

A successful knee reconstruction surgery will bring excellent results only in tandem with professional rehabilitation. The main goal of rehabilitation measures is the development of the joint, the restoration of functions and movements in the knee. And it is very important that the rehabilitation treatment is carried out correctly. Therefore, after the operation, our qualified rehabilitation specialist takes care of each patient. An experienced specialist conducts an examination and decides when and how to strengthen muscles and joints in each case so that recovery is as fast as possible.

How to develop a knee after a ligament rupture?

Many patients who are going to have a knee ligament injury are wondering how to develop their knee after surgery. Today there are a huge number of exercises that increase muscle tone and resume movement in the joint. However, in this case, one cannot rely only on one’s own strength and proceed to the development of the joint without consulting a specialist. After all, each case is individual and arrogance in the delicate matter of rehabilitation can only do harm. In the postoperative period, under the supervision of a specialist in the orthopedics clinic, patients perform static exercises, knee extension exercises, maintain strength in the calf muscles, quadriceps muscle, and train to walk on crutches. At this time, it is necessary to use a brace, do not overload the operated leg and listen to the recommendations of doctors.

Do the ligaments of the knee joint fuse?

If it is a minor injury to the knee ligaments, conservative therapy is sufficient to restore. If the injury to the knee ligaments has led to a rupture, the torn ligament fibers do not grow together. Torn ligaments in the knee are a 100% indication for arthroscopic surgery.

How long does a knee ligament tear heal?

Recovery after a knee ligament rupture takes 3 to 6 months on average. The terms of rehabilitation depend on how long ago the injury occurred, on the degree of damage, the age of the patient, and the general condition of his body.

first aid, methods of treatment, types, reasons, what to do

The knee joint is one of the largest and most complex in the human body. At the same time, this is a very fragile joint, which, in terms of the frequency of injuries, is comparable only to the ankle joint. This is due to the high stress that the knee bears when walking, cycling and skiing or playing football, as it carries the weight of the entire body as it moves. A knee injury is the most common reason people see a doctor. In case of minor injuries, conservative treatment is carried out, however, there are injuries when a surgical operation is necessary for recovery, followed by rehabilitation.

Content:

1. Causes of knee injuries
2. What are knee injuries: the most common cases
   1. knee fracture
   2. Dislocation of the knee
   3. Knee injury
   4. meniscus injury
   5. tendon rupture
   6. Knee sprain
   7. Tendinitis
3. Risk Factors Leading to Knee Injury
4. First aid for knee injuries
5. Treatment of knee injuries
6. Exercises to develop the knee joint after injury

Causes of knee injuries

Most often, athletes have knee injuries, but the knee joint can be easily damaged even in everyday life. The main causes of domestic injuries are:

• fall from a height;
• sharp extension and flexion of the knee;
• high jump landing on a straight leg;
• hit with a hard object in the knee joint;
• excessive twisting of the lower leg and thigh in opposite directions.

In addition, knee injury can occur in people who suffer from diseases that weaken the knee joint: arthrosis and arthritis, osteomyelitis, osteoporosis, bone inflammation caused by impaired collagen synthesis, lack of vitamins and minerals, and other pathologies.

To make an appointment, leave your phone number

What are knee injuries: the most common cases

Athletes and people whose work is associated with increased physical exertion should be aware of what knee injuries can be. The most common injuries are: contusion, dislocation, sprain and rupture of the medial or lateral ligament, fractures of the patella and bones (external and internal), violation of the integrity of the meniscus.

Important!

Any damage to the knee joint causes similar pain, therefore, to clarify the diagnosis, it is necessary to contact a traumatologist, who, using X-ray examination or CT, will accurately determine what kind of injury the patient has experienced.

Fractured Knee

Any bone in the knee joint can break in a fall, car accident, or impact with a hard object, but the kneecap is usually fractured. It is accompanied by severe pain, swelling, hemorrhage into the joint cavity due to rupture of blood vessels, and the inability to raise a straight leg. The diagnosis is confirmed by X-ray examination. In case of a fracture with a displacement of the bone, surgical intervention is indicated, during which the fragments are pulled together and connected to each other using plates and screws. If the fragments are in an anatomical position, it is recommended to wear an orthopedic fixator that holds the joint in the desired position, and to perform physiotherapy.

Dislocation of the knee

Dislocation of the knee is a serious injury in which one or more bones are displaced from their anatomical position. Causes include a sudden change of direction during a fall, an accident, a sharp knee rotation due to mechanical force. In many cases, the dislocation is painful, but is easily reduced by a traumatologist, followed by splinting. If, as a result of an injury, blood vessels and nerve fibers in the articulation area are damaged, there is a risk of developing ischemic complications. In this case, surgical treatment is necessary.

Knee contusion

Knee contusion is a traumatic injury resulting from a fall, a blow with a blunt object or a sharp rotation of the torso on a fixed foot, which occurred without compromising the integrity of the articulation structures. When bruised, the skin, subcutaneous tissue, and all intra-articular elements suffer. With a mild injury, capillary rupture does not occur, due to reflex spasm and vasodilation, edema and hematomas are observed. With a strong bruise, there is pain, severe hemorrhage, the affected tissues are saturated with blood. When it enters the articular cavity, hemarthrosis or synovitis is diagnosed.

Meniscus injury

The meniscus is a fibrous cartilage that acts as a shock absorber in the knee joint during movement. Injury to the meniscus of the knee joint is most often found in athletes, ballet dancers, people performing heavy physical work. If the meniscus is damaged, it is impossible to bend and straighten the leg, there are difficulties with climbing and descending stairs. Symptoms are characteristic clicks, pain, swelling, limited movement. When X-ray diagnostics and MRI in the joint, an accumulation of fluid is detected. When the cartilage is displaced, the orthopedist inserts them into place and applies a cast or splint. For small tears, arthroscopy of the knee joint is performed to relieve swelling, remove fluid and restore mobility. With extensive tears, an operation is performed to remove the meniscus.

Tendon Rupture

Tendon joints are located under the knee and are responsible for flexion and extension of the hip, keeping the body in an upright position when walking. Injuries are provoked by active sports, open fractures, knee injuries with sharp objects, improper load distribution, and age-related tissue degeneration. The main symptoms are intense pain in the knee and gait disturbance caused by difficulty bending the leg while walking. If you have difficulty lifting the straight leg, you should contact a traumatologist or orthopedist to do an x-ray examination and an MRI. If the rupture is confirmed, the patient will need surgery followed by a cast on the knee.

Sprain of the knee ligaments

Injuries of the ligaments of the knee joint are formed when the lower leg is twisted outward or inward, with direct blows, falling from a height, road accidents, and other multicomponent effects. At the time of injury, the victim feels a click and sharp pain. The mobility of the lower leg is impaired, swelling and hematomas may form, lameness, signs of joint instability may appear.

Diagnosis of fresh injuries is carried out under local anesthesia, x-rays are prescribed to exclude a fracture, MRI for layer-by-layer examination of ligaments, cartilage and tendons, ultrasound to determine the volume of synovial fluid. The leg is fixed with an elastic bandage, in difficult cases arthroscopy of the knee joint is prescribed.

Tendonitis

Tendinitis of the knee is an inflammatory process that affects the patellar ligament. Inflammation is localized in the area of ​​the tendon that connects the patella to the lower leg. The causes of the disease are microtrauma and constant overstrain of the tendon. The disease is most often diagnosed in athletes: athletes, football players, basketball players, tennis players. It is characterized by severe pain during extreme loads, as well as pain when pressing on the ligaments in a calm state. Predisposing factors are: foot pathology, wearing uncomfortable shoes, joint injuries, an ill-conceived training schedule, jumping on a hard surface, heavy weight.

To make an appointment, leave your phone number

Risk factors for knee injury

Risk factors for various types of knee injury include:

1. Overweight. Increases the load on the articular joints during normal movements, destroys articular cartilage, increases the likelihood of developing arthritis and arthrosis.
2. Weakness of the muscular system. Well-developed muscles hold and protect the joints from injury, increase the range of motion.
3. Chronic injuries and inflammations. Poorly healed previous injuries to cartilage and bone tissue increase the risk of new injuries.
4. Active sports activities. Increase the load on the knee joint and increase the risk of injury basketball, football, hockey, skiing, jogging.

First Aid for Knee Injuries

For those who play sports or work that involves heavy physical exertion, it is important to know how to determine which knee injury has occurred in order to provide first aid to the victim. This is a standard procedure that requires:

1. Provide peace. The person should be laid on a flat, hard surface and slightly raise the injured leg by placing a pillow or roller under it.
2. Put a splint or pressure elastic bandage on the leg (except for a broken joint) to fix it in a stationary horizontal position.
3. Apply ice to the injury site for 2 to 3 hours. This will reduce pain and swelling.
4. In case of severe pain, give the victim any pain medication.
5. If there is an open fracture, stop the bleeding by applying a tourniquet to the leg above the injury, indicating the time. After an hour, the tourniquet must be loosened and shifted a little higher.

Important!

You can not independently set the joint in case of dislocation, touch the bone fragments in case of an open fracture or try to put them in place, warm up the knee within 48 hours after the injury, since there is a high risk of complications.

Treatment of knee injuries

Depending on the nature of the injury, knee injuries can be treated in different ways. Minor injuries are treated with conservative methods: therapeutic exercises, physiotherapy, medication. The most serious injuries are knee meniscus injury, anterior cruciate ligament tear and knee fracture. The Department of Surgery at the Garvis Clinic uses the most effective and safest methods of treatment:

1. Metal osteosynthesis. It is performed with multi-comminuted, periarticular and intraarticular fractures of bones. During the operation, the traumatologist-orthopedist installs metal implants that allow you to match and hold the bone fragments in the correct anatomical position, which contributes to the rapid healing of the damaged bone.
2. Arthroscopy of the knee. A minimally invasive operation, indications for which are both chronic injuries that occurred more than 1 month ago, as well as fresh meniscus injuries, synovitis and other pathologies. During arthroscopy, 2 small incisions are made, into one of which a special solution is introduced to wash the articular cavity, and into the other – an arthroscope with a microvideo camera. The doctor sees the image on the monitor and can perform the necessary manipulations. The advantage of arthroscopy is the absence of negative consequences after the procedure.
3. Knee replacement. A complex endoscopic operation, during which a damaged and worn joint is replaced with an artificial one. Endoprosthetics is performed in case of improper bone fusion and the ineffectiveness of conservative methods of treating arthrosis, bone tissue necrosis, rheumatoid arthritis, purulent inflammation of the joint and other diseases.

To make an appointment, leave your phone number

Exercises to develop the knee joint after injury

Very often people are wondering what to do to prevent knee injuries. The answer is simple enough. Massage of the knee joint after an injury and a set of exercises will help reduce the risk of re-injury and restore knee mobility:

1. Sliding the heel on the floor. The exercise is performed in the supine position. The heel, without lifting off the floor, must be slowly moved to the buttocks and slowly returned to its original position.
2. Flexion of the injured knee with the healthy leg. Suitable for early rehabilitation after injury. Exercise is done while sitting on a chair. Placing a healthy leg over the patient, they try to bend the damaged knee joint as much as possible.
3. Knee flexion with belt. The patient sits on a chair and rests on a healthy leg. The ankle of the injured leg is secured with a strap that is wrapped around the leg of the chair, with the free end in the hand. It is necessary to pull the belt towards you so that the injured knee bends until pain appears in the thigh area.
4. Knee extension with support. Sitting on a chair and focusing on a healthy leg, the foot of the diseased limb is placed on a chair or cabinet so that the injured knee remains on weight. To extend the leg, you can use various weights.